A 50-year-old female presented with (1) angina on exertion, (2) intermittent claudication in the left lower limb, and (3) gradual blackening of the left foot for 2 months. She has a history of type 2 diabetes and hypertension for 10 years with irregular treatment. On examination, her left dorsalis pedis and posterior tibial pulses were diminished. Color Doppler showed diffuse thrombus in the proximal and mid left superficial femoral artery causing 67% stenosis and obstructed flow in the left popliteal, distal anterior tibial, and dorsalis pedis arteries.

1. Nirmala devi 50 years/ Female
Chief complain-
1-Angina on exertion (NYHA grade II) for 6 months
2-Intermittent claudication (Fontaine stage II) lt
lower limb for 6 months
3-Gradual blackening(gangrene) of Lt foot for 2
months
Past h/o-
K/C/O DM Type 2 and essential hypertension for 10
years on irregular treatment in the form of oral tablets.

2. Left foot

3. Non smoker.
On examination-
General examination-
PR-94/min,regular.
BP- 150/84 mmHg

4. Peripheral pulses
Carotid Brachial Radial Femoral Popliteal Post D.Pedis
tibial
Left + + + + - -
Diminish
ed
Right + + + + + + +

5. Systemic examination—
Chest- B/L Clear
CVS - s1 s2 normal.
no murmur.

6. 2D ECHO-
No RWMA,LVEF 60%
Grade I DD
Concentric LVH
Rest normal study
Colour doppler lower limbs-
Lt LL- Diffuse thrombus in proximal and mid SFA (67%
stenosis) with obstructed flow in popliteal,distal ATA and
DPA.
Rt LL-Normal study

7. Arterial supply of Pelvis

8. Arterial supply of lower limb

9. Arterial supply of lower limb

10. Arterial supply of lower limb

11. Arterial supply of lower limb

12. THANKS